Provider Demographics
NPI:1912095449
Name:MOORE, AMY MICHELLE (RNFA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 KINGSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3334
Mailing Address - Country:US
Mailing Address - Phone:214-695-8328
Mailing Address - Fax:972-495-9877
Practice Address - Street 1:813 KINGSBRIDGE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3334
Practice Address - Country:US
Practice Address - Phone:214-695-8328
Practice Address - Fax:972-495-9877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658702163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049KEOtherBLUE CROSS BLUE SHIELD